The investigators from the Care Quality Commission discovered that staff were routinely forging certificates, largely involving doctors pre-signing consent forms without seeing patients.
In total, 14 NHS hospitals have been formally censured by regulators over potentially illegal abortions.
The 249 inspections were carried out as part of an inquiry ordered by Andrew Lansley, the Health Secretary, after an investigation by The Daily Telegraph found evidence that the law was being broken.
Under the 1967 Abortion Act, doctors are allowed to carry out a termination if they believe the physical or mental health of a pregnant woman is in jeopardy.
Before carrying out the termination, two doctors must sign a form certifying that they are both “of the opinion, formed in good faith” that to continue the pregnancy would be inappropriate.
The Department of Health guidance warns that, unless the guidelines are followed, doctors may have committed a criminal offence. Police are now reviewing the evidence at all 14 NHS trusts.
One of the most stark findings was made at the Princess Alexandra Hospital in Harlow, Essex, where staff used a box of certificates signed by a doctor who no longer worked at the clinic.
“This demonstrated evidence of a doctor either providing to others or knowingly allowing others, to use forms signed in advance by them or photocopied with their signature,” the inspectors concluded. “It also showed evidence of a doctor signing and/or dating a blank form in advance with a ground for abortion, without reaching an opinion in good faith.”
At Leicester General Hospital, 14 out of the 20 medical records were photocopied.
At King’s College Hospital in south London, inspectors found that there “were inconsistencies in the evidence” that would “give rise to a risk of unsafe or inappropriate care and treatment”. Inspectors looked at nine people’s medical records and found that “in all nine cases both doctors’ certification of opinion predated the referral”.
At the Royal Victoria Infirmary in Newcastle upon Tyne, the inspectors found that “in 13 out of 20 forms .?.?. the first doctor’s signature was photocopied” and that “the photocopied signature appeared to be that of the same doctor on all 13 forms”. In one of the cases, the two doctors’ signatures had been obtained four and five weeks respectively after the patient’s pregnancy was terminated.
At Peterborough City Hospital, inspectors found that doctors had signed paperwork about people’s suitability for termination “before the people concerned had been assessed”. Inspectors noted similar cases at Scunthorpe General Hospital.
At the Central Health Clinic in Bristol, the majority of patients were assessed initially by a nurse, using a pre-signed form.
If the patient was booked in for an abortion, the surgeon who performed the procedure signed the form as the second-opinion doctor.